Postgraduate medicine
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The adult respiratory distress syndrome (ARDS) is an extreme form of noncardiogenic pulmonary edema associated with alveolar-capillary damage. Clinical features include acute respiratory distress, dyspnea and tachypnea, severe hypoxemia refractory to oxygen therapy, and diffuse bilateral pulmonary infiltrates. ⋯ Treatment includes positive end-expiratory pressure, careful fluid management, steroid therapy, and adequate nutrition. Unfortunately, even with the most sophisticated intensive care, the mortality of ARDS is still greater than 50%.
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Postgraduate medicine · Jul 1983
The comatose patient. A systematic diagnostic approach for you to follow.
Coma is a frightening state requiring immediate medical attention. Because the patient's history may be unavailable and the possible causes of coma are numerous, the physician must concurrently support and protect the patient and evaluate the cause of coma. A systematic, orderly approach to diagnosis, using modern diagnostic tools to complement thorough physical examination, can help illuminate and alleviate this often perplexing problem.
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Postgraduate medicine · Jun 1983
Fungal infection of the lung. The big 3--histoplasmosis, blastomycosis, coccidioidomycosis.
Diseases caused by the normally pathogenic fungi Histoplasma capsulatum, Blastomyces dermatitidis, and Coccidioides immitis are common but seldom serious. Treatment is usually needed only if respiratory status is compromised, if there is progressive tissue destruction, or if the infection disseminates outside the lungs. ⋯ Although this drug has no firmly established role, it has proved useful for several aspects of disease. More experience with its use will prove whether it is truly curative or merely suppressive.
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Postgraduate medicine · Jun 1983
Comparative StudyNarcotics for acute postoperative pain. Is intramuscular administration passé?
Intramuscular (IM) injection of narcotic has been the mainstay of postoperative analgesia. However, problems inherent in IM administration--pulmonary dysfunction and inadequate pain control due to variable peak levels of drug concentration and variable absorption rate--have resulted in continuing efforts to find a more desirable method of administration. Intravenous (IV) infusion on a continuous or self-administered intermittent basis controls pain more effectively than IM injection. ⋯ Some investigators are studying injection of narcotic into the epidural or subarachnoid space of the spine as a means of providing postoperative analgesia. This method provides an unusually intense, prolonged, and segmental analgesic action, as well as greater improvement in respiratory dynamics than with IV infusion. Although the advantages of the IV and spinal methods seem to outweigh the disadvantages, further research is needed before they can be recommended as alternatives to the standard IM method used to control postoperative pain.